Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 32838 | IA |
NPI | 1013992205 |
---|---|
Provider Name | Leon L Qiao |
First Address | Cedar Rapids, IA 52401-2121 |
Second Address | Cedar Rapids, IA 52401-2121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 07/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1211771 | (05) | IA |
H54355 | (02) |